Laboratory services can bolster population health and the move toward value-based care by supporting prompt diagnoses and comprehensive medication management for large populations, said speakers at the 22nd Population Health Colloquium.

Ongoing developments in patient behaviors, health services, data analytics, and technology have brought the health care industry to a pivotal point in history, which may allow for major improvements in population health management and a natural transition toward value-based care, said Rebecca J Wang, MBA, executive director, Quest Diagnostics.

Laboratory data is a key component of population health management, Ms Wang said. These data are the basis of up to 85% of diagnoses and treatment choices, as well as 70% of the information in an average patient’s medical record.

Laboratory services only account for 2% to 3% of health care spending, and making sure tests are ordered appropriately and in a timely manner will ensure this money is being used as efficiently as possible, Ms Wang said.

“We have to make sure we’re not over-ordering tests—that we’re ordering the right tests for the right patient at the right time,” Ms Wang said. “It may mean marrying the lab test with other services, like data analytics or patient engagement, to make that 3% more meaningful.”

The “Lab 2.0” framework, under which Quest Diagnostics operates, incorporates clinical action, data analytics, and cooperation between stakeholders to achieve the quadruple aim of health care, Ms Wang said.

One component of the model involves private and public partnerships with policymakers, payers, providers, and other stakeholders. Engaging patients is also important, Ms Wang said, as providers may have a more difficult time implementing effective care if patients are not engaged.

“It is not just about the lab supporting individual clients. It is about how to work together as a health care network to support our patients and drive outcomes,” Ms Wang said.

Value-Based Care and Costs

Health care costs are rising in the United States, but the quality of care remains highly variable. Value-based programs present an opportunity to improve both, said Simone Sandler, MBBS, MPH, senior director, Quest Diagnostics, in the second part of the session.

Despite the strong rationale driving the shift toward value-based care, uptake has been slower than experts anticipated due to significant challenges surrounding its execution, Ms Sandler said. Barriers to uptake include issues with measurement and reporting infrastructure, administrative burden, scalability, and appropriate compensation for the value created, among others.

“I think we all agree that population health is a powerful tool for value-based care because it achieves both significant quality improvement and downstream cost avoidance,” Ms Sandler said. “The real sweet spot is at the intersection…where population health programs are leveraged against risk-based contracts to lead to improvements in patient outcomes and costs.”

Laboratories can support cost and quality improvements for populations by preventing over-utilization of services and providing high quality testing, fast turnaround times, clinical guidance, and screenings recommended by the US Preventive Services Task Force, Ms Sandler said.

It can be difficult to measure the impact of laboratory services on health care costs, however, since most cost savings and health improvements are observed long term rather than at the time of service.

“Lowering spend on lab is a little limited given that spend on lab…is quite low compared to other expenses. We need to think more creatively about how to leverage lab to lower downstream cost, rather than lowering spend on lab directly,” Ms Sandler said.

The Role of Pharmacogenomics

Steven E Goldberg, MD, MBA, vice president, and chief health officer, employee and population health, Quest Diagnostics, went on to review how genomic testing by laboratories can help lower costs.

Medication management accounts for more than $500 billion in annual spending in the United States, and over two-thirds (68.7%) of clinical visits involve drug therapies in some way. Medication errors, inaccurate prescribing, adverse events, and issues like missed doses and failed treatments can all impact patient outcomes and industry costs, Dr Goldberg said.

“How we’re getting medications out, how we’re engaging [patients], the money we’re spending—it’s not optimally working for individuals or populations. Pharmacogenomic insights can be a part of offering a solution,” Dr Goldberg said.

Pharmacogenomics is the study of how inherited genetic differences impact the way drugs or medications affect a person. This may include how fast a patient metabolizes drugs, how a patient might respond to a medication, and how likely a patient is to experience adverse events or a suboptimal response—all of which can support providers in making dosing decisions and reducing the time and money required to find the right medication for a patient through trial and error, Dr Goldberg said.

“Pharmacogenomics is a diagnostic insight. It’s our view that it is a component that is best served [as] part of comprehensive medication management,” Dr Goldberg said.

To illustrate his point, Dr Goldberg shared a preliminary analysis conducted by Quest Diagnostics regarding the effectiveness of a medication safety program. Using medical claims from 2020 to 2022, investigators found a combination of pharmacogenomics and comprehensive medication management reduced costs and utilization across emergency department, in-patient, and outpatient settings for 638 employees.

Additionally, a case study by Coriell Life Sciences showed the use pharmacogenomics was associated with significant improvements in average annual savings per patient and curbing cost increases by 12%, Dr Goldberg said.

Coverage for pharmacogenomics is limited and follows a model in which select individuals are authorized to receive testing to arrive at a diagnosis, Dr Goldberg said. By contrast, leveraging pharmacogenomics at the population health level requires a new model, wherein stakeholders engage entire populations across all medication regimens and diagnoses to catch and treat health issues earlier, he said.

“Our early data suggests when you use that [model], you can drive significant value for a self-insured employer with a commercial-age population,” Dr Goldberg said. “I think that’s new; I think that’s different; I think that’s disruptive.”